Cultures matter in microbiology
Authors: None The Lancet Microbe
Journal: The Lancet Microbe (2023)

Over the past decade, it has become increasingly established that considering local cultures in medical research is crucial to ensuring that health interventions are effective. In 2014, the Lancet Commission on Culture and Health called for researchers to consider how the social determinants of disease affect biology and not just the other way around, concluding: “an understanding of the effects of sociocultural processes on biological ones has been largely neglected and should become a main focus of research”. Since the publication of this Commission there has been a noticeable change in how sociocultural factors have been integrated into studies on infectious diseases. This issue of The Lancet Microbe features three studies that show why considering local contexts is valuable to microbiological research. First, Jake Lacey and colleagues retrospectively sequenced group A Streptococcus (GAS) isolates that were collected in three remote Aboriginal communities in the Northern Territory of Australia and identify asymptomatic carriage of GAS in the throat as a potential driver for the relatively high rates of impetigo seen in these communities, possibly explaining why interventions targeting only skin infections had little success. The authors discuss how inadequate housing and plumbing could be exacerbating GAS carriage in these communities, suggesting that alleviating clinical symptoms without addressing the sociocultural context will not be effective in reducing impetigo incidence. Second, Camille Morgan and colleagues analysed routinely collected data to gain insights into animal ownership and the prevalence of Plasmodium falciparum malaria in the Democratic Republic of the Congo. The findings showed that owning chickens was associated with more P falciparum infections, whereas cattle ownership was associated with fewer infections. These findings contrast with some studies from other African countries where cattle have been found to not have a zooprophylactic effect, leading to the conclusion that understanding animal husbandry practices within communities will inform local interventions that can bolster ongoing national malaria control programmes. Finally, Derek Cocker and colleagues present a longitudinal study of 330 rural and urban households in Malawi that examined the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. 11 975 samples from people, animals, and surrounding water sources were tested for these ESBL-producing Enterobacterales and households were surveyed on antibiotic use, health-seeking behaviour, animal husbandry, and household sanitation practices. The findings showed an association between human ESBL-producing Escherichia coli and wet season, living in urban areas, and animals being kept inside. These studies show how combining measures of local context with microbiological data can lead to meaningful insights. But translating such research into local interventions is more an art than a science. The 2014 Lancet Commission stated: “creation (or restoration) of wellbeing demands that patients have options that are real to them and that encourage them to live lives that they have reason to value”. For example, there are international calls to ban so-called wet markets to prevent spillover events; however, these markets will not disappear if the people who rely on them are not involved in these conversations. Similarly, building houses for Aboriginal communities in Australia, preventing chickens from being close to houses in the Democratic Republic of the Congo, or building outhouses for animals in Malawi will likely not succeed in protecting the health and wellbeing of local people if those interventions do not account for local needs and values. Instead, community-informed partnerships with academia should be encouraged to ensure that research is applied and the interventions sustained. It is important to note that these three research papers are studies of association, not causation. For the findings to be put into practice researchers need to codevelop solutions with the communities. Facilitating such bottom-up advocacy is challenging because context-specific research is frequently less attractive to global policy and funding, often due to a perceived lack of generalisability. But this perception is an oversimplification as looking at local communities can often tell us more about human behaviour than large multicentre trials. The papers featured in this issue may be specific to the communities they study, but they show that context-specific research that applies a broad One Health approach produces helpful and holistic conclusions. Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysisIn communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. Full-Text PDF Open AccessAssociation between domesticated animal ownership and Plasmodium falciparum parasite prevalence in the Democratic Republic of the Congo: a national cross-sectional studyOur finding of a protective association conferred by cattle ownership suggests that zooprophylaxis interventions might have a role in DR Congo, possibly by drawing An gambiae feeding away from humans. Studies of animal husbandry practices and associated mosquito behaviours could reveal opportunities for new malaria interventions. Full-Text PDF Open AccessInvestigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort studyThere are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting. Full-Text PDF Open Access